Let’s Talk: Eating Disorders
Dr. Anjali Mediboina, House Surgeon, ASRAM
Whenever I come across the term “eating disorder”, two characters come to mind: First, Lily Collins’ character in the movie To the Bone, and second, Hanna Marin from Pretty Little Liars. The former character had anorexia nervosa, while the latter was implied to have bulimia.
Let me just briefly explain what eating disorders actually are:
“Eating disorders (ED) are behavioral conditions characterized by severe and persistent disturbance in eating and feeding behaviors and are associated with distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological and social functioning of an individual .”
Apart from these, there are some conditions not recognized by the DSM-5 that I believe should be known as well:
- Orthorexia nervosa: An unhealthy focus on eating in a healthy way; here the individual is extremely concerned about the “purity” of the foods they are eating.
- Night Eating Syndrome (NES): An eating disorder where the individual wakes up several times throughout the night to eat.
So, are eating disorders purely psychological?
Based on the research available, disorders such as anorexia, bulimia and orthorexia have links to psychological issues; the former two are associated with the individual’s unhealthy obsession with losing weight, while in the latter, the individual is obsessed with the “healthiness” of the food they are eating.
Pica is usually associated with nutritional deficiencies, usually iron deficiency anemia. It is also associated with developmental disorders and intellectual disabilities.
ARFID seems to depend on the person. It can be due to picky eating, anxiety regarding the consequences of eating (vomiting, choking, etc) or due to sensory sensitivities for people on the Autism spectrum.
NES is linked to circadian rhythm disorders, genetics and mental health issues such as anxiety and depression. NES is also associated with Binge Eating Disorder, which in turn has been associated with mental health disorders.
Is therapy the only treatment for EDs?
Yes, counselling is the major aspect of treating an ED. In most of these cases, outpatient therapy will suffice, however in anorexia, inpatient or residential rehabilitation is recommended to ensure weight is restored and eating behaviors are normalized.
Along with counselling and therapy, treatment of EDs includes medical evaluation, treatment of any co-occurring psychiatric/medical conditions and formulating a proper nutritional plan.
Unfortunately, with the emphasis being placed on one’s looks, due to the increased usage of social media, eating disorders are quite underrated when it comes to mental health problems, because of which there is some knowledge gap among us doctors. Here are several myths I’d like to debunk:
Myth #1: Eating Disorders mainly occur in women.
Wrong. Eating Disorders can occur in anyone, regardless of gender. In fact, a research paper by Ahlich et al. , have reported that 25% of people with EDs are represented by cisgender males.
A research paper by Eichstadt et al.  talked about the occurrence of EDs in male athletes and cited the following causes for EDs in men:
“A number of factors contribute to elevated ED risk among men, including psychological factors, gender role expectations, media portrayals of dieting and exercise, conflation of muscularity and masculinity, social media messages increasingly targeting body shape, and excessive changes in weight .”
Myth #2: People with anorexia are extremely thin.
People with anorexia may be underweight, with BMI generally below 18.5; HOWEVER, just because a person has anorexia, doesn’t mean they will be underweight. There is a condition known as atypical anorexia, which comes under the “Other Specified Eating and Feeding Disorders”. Here, the features of anorexia are present, without the person being underweight.
It should be mentioned here that, there is a general impression that ‘Thin People = Eating Disorder’. Disorders such as Binge Eating Disorder and Night Eating Syndrome are usually associated with obesity. In fact, associating body weight with eating disorders is extremely wrong; athletes such as Olympic figure skater Adam Rippon came forward to talk about his severe eating disorder- you’d never expect an athlete who appears to be physically fit to have an eating disorder, would you?
Myth #3: “____ (person) can’t have an eating disorder; they eat well enough.”
It’s not about whether they’re eating or not, rather it’s about whether, they’re eating enough for normal growth and development or to support the physical activities the person engages in.
Myth #4: “Some kids are just picky eaters; it’s not an eating disorder.”
True, kids can be picky eaters. But, extreme pickiness can be a problem, and comes under ARFID (Avoidant restrictive food intake disorder). Disliking a particular food item is one thing, but being afraid of it or avoiding an entire food group will require medical intervention.
Myth #5: “People with eating disorders just need to eat healthy food, they’ll be fine.”
This type of thinking is extremely harmful. Eating disorders are a mental illness and need proper medical attention to recover in a safe way. EDs are usually associated with anxiety, depression, trauma and/or self-injurious behaviors, so eating less or more is not the issue . Rather, the root cause or incident that led to the development of the ED in the first place must be addressed.
1. What are Eating Disorders? [Internet]. Psychiatry.org. 2021 [cited 16 August 2022]. Available from: https://psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
2. Ahlich E, Choquette EM, Rancourt D. Body talk, athletic identity, and eating disorder symptoms in men. Psychology of Men & Masculinities. 2019 Jul;20(3):347.
3. Eichstadt M, Luzier J, Cho D, Weisenmuller C. Eating disorders in male athletes. Sports health. 2020 Jul;12(4):327-33.
4. Jacoby S. Olympic Figure Skater Adam Rippon Reveals His Experience With Disordered Eating [Internet]. Self.com. 2018 [cited 16 August 2022]. Available from: https://www.self.com/story/olympic-figure-skater-adam-rippon-disordered-eating